Emergency management of Maxillo-Facial / Dental / Oral Injuries (Guidelines)

This is a list (not exhaustive) of common facial trauma presentations and comments about management:

• For all displaced fractures of facial skeleton contact OMFS ARI for advice.
• If local (Raigmore) review requested by ARI OMFS then please email : nhsh.oral@nhs.scot or tel x5528/4282/6179 

Zygomatic complex fractures  (zygomatic body, arch, orbital rim, orbital floor)

• Refer to ophthalmology if diminished visual acuity or diplopia/pain with eye movements & discuss with ARI OMFS.
• For undisplaced/minimally displaced fractures - oral surgery clinic review   
• Advise to refrain from nose blowing.

Mandibular fractures

• If fracture of tooth bearing segment (body) and if displaced/mobile discuss with ARI OMFS or admit for IV antibiotics and assessment following day prior to transfer to ARI.
• If undisplaced/firm and dental occlusion (bite) not deranged, then oral surgery clinic review following day/Monday.

Condylar fractures

• If not associated with body fracture, then oral surgery clinic review: 3 to 5 days (undisplaced and displaced)

Dento-alveolar fractures (fractures of tooth bearing segments of jaw with teeth but jaws otherwise intact)

• Please contact oral surgery, Raigmore

Mid third facial fractures

• Usually severe injuries, often poly-trauma requiring admission
• Contact ARI for management
• Advise to refrain from nose blowing

Oral Surgery:

• In hours (urgent) contact Oral Surgery OPD (via x6179, x5528, x4282)
• For clinic r/v please email nhsh.oral@nhs.scot

Emergency Dental Service:

• Access to Emergency dental service – (in hours/OoH) for patients not registered with a dentist
• For patients, direct contact:
  • Mon to Fri 0845 to 1700 Dental Helpline on 0800 141 2362
  • Mon to Thurs 1800 to 0830 NHS24 on 111
  • Fri 1800 to Mon 0830 NHS24 on 111
• Professional to Professional contact number (NOT for patients) 
  • Sat to Sun 0830 to 1800 for direct contact 
  • 07786 174085 or 07818 687268 to contact OoH Clinic Head Dental Nurse
  • Use when direct transfer of care to OoH dentistry is clinically appropriate

• ARI: acute respiratory infection
• ED: emergency department
• ENT: ear, nose and throat
• HI: head injury
• MOI: mechanism of injury
• OMFS: Oral and Maxillofacial Surgery,
• OOH: out of hours
• OPD: outpatients department